Virtual Pre-Symposium Session Presenters

Dung Trung Bui is a PhD candidate at the Centre for Rural Health (CRH), University of Tasmania. He has a background in the Doctor of Medicine program and worked as the Continuing Medical Education manager in a government hospital in Hanoi, Vietnam. He has worked with an extensive network of training units of provincial general and specialist hospitals in Northern Vietnam regarding practical skill training programs with purposes of enhancing the professional capacities of medical staff there.

He is interested in many aspects of public health, but particularly medical education, hospital management and oral care. He has several publications, written in both English and Vietnamese, in domestic journals in the areas of e-learning, oral care, health care leadership, and machine learning technique. He has studied at the CRH since August 2018. His PhD thesis relates to the application of technologies to enhance the remote learning of health care workers in rural and remote areas in Australia.

Background: Many remote areas in Australia suffer from the inadequate quantity, skill set, and skill mix of the health care workforce. Telementoring activities can potentially offer a solution to maintain professional skills of more isolated rural health care workers ‘at a distance’. It is a method using a technological communication device to provide instruction from an expert to a local, less-experienced practitioner at a different geographic location in real time. The incorporation of augmented reality (AR) technology into telementoring systems has been reported. Augmented reality is defined as a form of immersive experience in which the real world is enhanced by computer-generated three-dimensional content, which is overlaid on the real environment. However, there is a gap in identifying the true value and usefulness of AR in mentoring clinical care professionals remotely.

Aims: To compare the learning outcomes of students receiving AR-based telementoring with traditional instruction mentoring for management of a complex clinical care scenario.

Methods: This study will use a randomised control trial design. Second-year nursing students at the University of Tasmania (UTAS) are randomised into either the experimental group using HoloLens under telementoring conditions or the control group who receive usual instruction. The scenario of acute myocardial infarction is selected among 20 patient cases that make up the Australian and New Zealand Nursing Education scenarios. Simulation labs in UTAS are set up to be a standard emergency room to run the scenario. Skill performance checklists will be used to measure the learning outcomes of participants. As secondary outcomes, the perspectives of participants on the AR device’s performance will be assessed by the System Usability Scale. The NASA Task Load Index will also be used to determine the mental workload of participants while they are practicing in the scenario.

Significance: This study contributes to the overall continuing medical education of rural health care workers, particularly in the areas of health service delivery, workforce qualification, and workforce retention. It provides rural health care workers access to the professional practice from a far distance. The study also promotes understanding of advanced technologies in remote assistance between the urban and suburban communities.

Dr O'Sullivan is a research academic in rural health workforce with longstanding involvement in Australia's MABEL study. Belinda currently works at the University of Queensland, having previously led the Monash Medical tracking study and led the evaluation framework for the National Rural Generalist Pathway.

Background: Globally, rural pathways are essential to recruit, train, support and retain a generalist rural health workforce and thereby improve rural health outcomes. However, the components of rural pathways, and range of actions needed within comprehensive pathways are not well conceptualised. Many countries, regions and communities are seeking guidance as to effective action, and low and middle income countries (LMIC) in particular require targeted support.

Objective: This WHO-sponsored project involved the development of a Rural Pathways Checklist, as a complete guide to the implementation of rural pathways in a range of contexts, sensitive to LMIC settings, various health workers, stakeholders and starting points.

Method: The Checklist was developed by way of a global Steering Committee, who led concept testing through two LMIC-specific focus groups, defining principles, undertaking a scoping review drawing on LMIC-published evidence, doing an analysis of LMIC rural health policies and three stages of virtual consultation with a global Expert Reference Group in 2018.

The Checklist applied the WHO rural retention guidelines to cover all aspects of the rural pathway to recruit, train, support and retain rural health workers, specifically in LMIC settings. It allows for different problems and starting points, tailored to context.

The Checklist was field tested at international conferences/workshops and via online dissemination-feedback loops.

To enhance its application to real-world problems, a Checklist self-assessment tool was developed based on the Checklist evidence in each action (allowing people to self-rate progress and identify actions relevant to context, barriers and enablers).

Results: The Checklist included eight core action areas: establishing community needs, policies and partners, exploring existing workers and their scope, selecting health workers, education and training, considering working conditions for recruitment and retention, accreditation and recognition of qualified workers, professional support and up-skilling and monitoring and evaluation.

For ease of use, each action area has a series of reflective questions and summary of evidence.

The Checklist comes with exemplars of best practice from different WHO global regions to guide others.

By addressing all the components of rural pathways and the actions to implement them, it provides an avenue for advocacy and action to achieve more trained and qualified rural generalists, retained in rural communities, worldwide. This includes the capacity to move between actions, given that rural pathways implementation is an iterative process.

Field testing demonstrated it is applicable to various settings, health workers and stakeholders and a valuable document for planning and benchmarking rural pathways. The self-assessment tool allowed stakeholders to benchmark the health of their rural training pathway specific to a local problem and plan solutions.

Conclusion: This important project of the WHO signals a significant step forward in conceptualising and developing rural pathways, for improving health outcomes and promoting social and economic development of rural communities around the world, particularly LMIC.

Dr Slater is a nurse practitioner with the statewide Paediatric Palliative Care Service, incorporating clinical care, support and education across the state for children with palliative care needs, their families and health professionals involved. She is continuing to advance this specialist field on a national and international level.

Aims: The Quality of Care Collaborative Australia (QuoCCA) has provided education for health professionals in paediatric palliative care (PPC) across Australia since 2015, with the aim to improve the quality of services in regional areas. Pop-up education aims to improve care provided to children and young people who have a life-limiting illness with palliative care needs, with a focus on education and support of regional teams.

Relevance: The lessons learnt from the QuoCCA project will be applied to the context of a successful model of delivering support to families and local health professionals to care for the patient and family when they return home.

Methods: National education in PPC through QuoCCA has been achieved through a collaboration of six tertiary PPC services, with educator and support positions funded by the Australian Government Department of Health.

The project includes pop-up and scheduled visits, as well as incidental sessions in the team’s hospital and community settings. Education was provided in Indigenous communities, detention centres, metropolitan and rural and remote areas in all states and territories of Australia.

The education was evaluated through impact surveys completed before and after the session with responses related to knowledge and confidence across nine domains. A case study is presented to illustrate the outcomes from one such experience, with quote provided by health professionals.

Results: A pop-up was a creative way for the specialist paediatric palliative care team to support regional teams. The palliative care team liaises with local teams and care providers to arrange the QuoCCA visit, and there is ongoing discussion with the QuoCCA educator, clinical teams and the palliative team regarding logistics and needs. The visit provided in-time education, peer support, clinical handover/teaching, coordination of resources, identifying a 24-hour support for the family, strengthening communication strategies and an opportunity for professional growth.

The poster presents a case study of a 12-year-old with devastating neurological complication secondary to bone marrow transplant, who was facing only days of life. The care needs were very complex with high symptom burden and required extensive skin care. The family were wanting to be home to country as soon as possible. The local team was a very small rural hospital with limited resources and limited capacity to care for sick children as an inpatient, but they were very keen to support transfer to home and try to meet the family’s wishes.

Feedback from the health professionals involved is included.

Conclusions: QuoCCA has enabled rapid change in workforce capability in PPC in Australia, enhanced quality of service delivery and access to PPC in a geographically dispersed population of children with PPC needs and their families.

Next steps include examining sustainability of this model, with creative funding models, a focus on the pop-up style education and support, continued national collaboration and writing up journal articles.

Rory van der Linden is a University of NSW medical student based at the Port Macquarie Rural Clinical School. His interest in rural medicine and primary care stems from his experiences growing up on Kangaroo Island, South Australia, and travelling around Australia with his family in search of good waves and beautiful scenery. Rory has recently completed the research component of his MD in which he investigated the treatment of childhood obesity in the Australian primary care setting. Rory will complete his final clinical years in Port Macquarie with an aim to ultimately enter a rural general practitioner pathway through either the RACGP or ACRRM. 

Background and objectives: Childhood obesity (COb) is a growing global pandemic with the number of obese children worldwide set to increase by 50% by 2025. Among Australian children (5–17 years), prevalence of overweight and obesity has risen from 21% in 1995 to 27% in 2015, with those living in Outer regional/Remote areas up to 1.5 times more likely to be above a healthy weight than those in Major cities. In addition, those within the lower socio-economic groups, and Australian Indigenous people are more likely to be overweight or obese. This not only affects the individual but has a cascading impact on the broader community and health care system. General practitioners (GPs) are identified as important figures in COb management, and despite them considering it a top health care priority, their provision of treatment does not match guideline recommendations. This research aims to evaluate GPs’ management of COb in general but will also investigate differences between metro and regional/rural doctors.

Methodologies: This mixed methods, cross-sectional survey study incorporated qualitative and quantitative questions in a short online questionnaire distributed among Australian GPs. The survey included questions which assessed knowledge, confidence, and attitudes towards COb management in clinical practice. It evaluated these areas with respect to various demographic factors including location of practice, gender, and experience.

Results: Responses from 239 Australian GPs were recorded and analysed; of those, 127 respondents practiced in regional or rural settings. Overall, GPs demonstrated varied knowledge with just 20% accurately defining COb and overall knowledge of guideline recommendations being moderate to high. Confidence in clinical scenarios relating to COb was high, however, GPs were not confident in community support options available for COb management. Rural and less experienced GPs were significantly more likely (p<0.032) to cite time and the potential for negative parental or child reactions as strong barriers to COb management than other GPs.

Discussion: The current study offers new insights into Australian GPs’ knowledge of COb; it explicitly assesses respondents’ knowledge of the guidelines, demonstrating that GPs should collectively improve their COb related knowledge. It demonstrated the need to improve support for GP registrars and rural GPs, which is particularly important given the high rates of overweight and obesity in regional and rural Australia. The data reaffirmed that GPs require and want support in the form of multidisciplinary community management options; this is clearly documented in existing literature and leads to the study’s final conclusion that these findings must be collated and presented to governing bodies in order to drive change on an organisational level as progression in this area is currently underdeveloped.